Key Project: Analysis of California Multidisciplinary Teams (AB 210)
Executive Brief
Assembly Bill 210 (AB 210), enacted in 2017, authorizes California counties to establish Homeless Multidisciplinary Teams (MDTs) that coordinate housing, health, and social services for people experiencing homelessness. The law’s central purpose is to improve outcomes for individuals and families by enabling different agencies to share confidential information lawfully, thus breaking down silos between health, housing, and human services systems.
Key Aspects:
When done well, an MDT increases wellness for clients most underserved by the system, increases collaboration and communication between providers, reduces safety net utilization, increases efficiency of outreach efforts, and reduces homelessness. Challenges include maintaining privacy standards, maintaining staffing, and finessing an integrated data system.
Key Aspects:
- Each county must develop an information sharing/confidentiality protocol, train each provider, and maintain records
- The bill specifically targets adults or families experiencing homelessness, but most counties focus on those with complex needs who are involved in the social services system in multiple ways
- MDTs tend to include health (medical and behavioral) providers, human services/benefits eligibility, housing services, legal services, and engagement-focused programs. MDTs can also include emergency management, veterans services, and conservators.
- The bill permits, but does not require, information and data sharing. The bill specifies that this is for service coordination only, not law enforcement or other unrelated purposes.
- Most counties create integrated data systems and care planning.
When done well, an MDT increases wellness for clients most underserved by the system, increases collaboration and communication between providers, reduces safety net utilization, increases efficiency of outreach efforts, and reduces homelessness. Challenges include maintaining privacy standards, maintaining staffing, and finessing an integrated data system.
The Project
Scope of Project: Analyzed six MDTs in the State of California (San Mateo, Los Angeles, Santa Cruz, Orange County, Tulare County and San Francisco) to determine similarities, differences, client eligibility criteria, use of data, and operational processes.
Similarities:
- All programs bring together a variety of providers to collaborate – medical, behavioral health, housing, benefits, outreach/engagement, and justice-involved.
- All MDTs attempt to link unconnected clients with services and follow the clients to make that linkage stick.
- All MDTs formalized their information sharing protocols and established procedures for collaborating around confidential information.
Differences:
- Some programs (Orange County) rely heavily on utilization of the system (ED, jail, etc) to determine MDT caseload eligibility.
- Other programs (SF, Santa Cruz) incorporate referrals from MDT members and outreach workers to inform who should be added to the MDT caseload
- All of the programs met at different frequencies, from a couple times a week to a couple times a month.
Approach to Data:
- SF uses a centralized data system to determine system utilization. This helps screen clients prior to acceptance on the caseload and increases efficiency.
- Other programs (Orange County) have some connectedness between their data systems, but rely on real time updates to care plans for more ‘in the moment’ data.
- The remaining programs did not publish rich information on how they approach and use data within the MDT.
Approach to Care Planning:
- Certain programs (Santa Cruz) develop problem lists for each client to ensure each entity participating in the MDT remains focused on the same issues.
- Other programs (Orange County) aim to see utilization decrease over time and move clients to more intense care planning if utilization increases.
- SF mixes their data pulls with real time feedback from outreach workers to determine next steps in care planning.
Best Practices for an MDT:
- Determine client eligibility, triage procedures, who can make referrals, and how this process will change as implementation moves forward.
- Centralize and automate as much data reporting as possible. (Much easier said than done.)
- Name leads (both clinical and operational) to support the MDT, trouble shoot issues, and maintain consistency throughout implementation.
- Meet with the frequency at which you want change to occur. Meeting more frequently allows for iteration and quick adjustments to care planning, operational issues, and overall flow.
- Formalize and train staff on information sharing, confidentiality, and how to navigate client collaborations with programs they might not regularly coordinate with.
- Apply a racial equity framework to the processes, training, and workflows. Solicit feedback from staff and clients.
The legislation establishing MDTs, Assembly Bill 210, was enacted in 2017. In the years since, many cities and counties have experienced increases in homelessness and have turned to the MDT structure as one potential strategy for improving coordination and response. Intensifying political scrutiny and public pressure surrounding homelessness, particularly following recent legal developments such as City of Grants Pass v. Johnson (2024), has also accelerated interest in MDTs as a policy tool. However, AB 210 does not require jurisdictions to publicly report on MDT operations, data-sharing practices, or outcomes, creating significant variation and limited transparency across counties.
This project demonstrates the need for additional research to identify effective MDT models and operational standards, such as outcomes evaluation, process evaluation, fidelity studies, and comparative analyses between counties. New practices often take years to be documented, refined, and validated in the literature, and MDTs are no exception. Although multidisciplinary teams are well established in other social service contexts, this specific form of MDT, one that integrates emergency management, law enforcement, behavioral health, public health, and housing providers, is a relatively recent innovation intended to address homelessness among individuals with complex needs. Continued study will be essential to understand whether these teams are achieving their intended outcomes and how they might be improved.
Professional Development
Professional development is key for social work. I completed a training in trauma-informed leadership to aid in my project formation and analysis.
